Transcript Medical Barriers to care

Alicia Galvan, DDS, FAAHD
Geriatric Dental Group of South Texas
December 2, 2011

UTHSCSA Dental School 2002

2 Yr. GPR Residency at UTHSCSA Dental and
University Health System

Fellow of the American Association of Hospital
Dentists

2004 – 2010 AEGD and GPR director UTHSCSA
Dental Postgraduate Dept.

2010 – present, associate at Geriatric Dental
Group of South Texas
 Describe
systemic health issues which are
common to the geriatric patient
 Describe
how these systemic health issues
may present an obstacle in providing
dental treatment for the geriatric patient
 Methods
for overcoming common obstacles
to dental treatment

When the baby boom generation enters its senior years,
between 2010 and 2030, it is projected that one in five
Americans will be over 65

Major health issues affecting geriatric patients include
cardiovascular disease, kidney and endocrine disease,
psychiatric illnesses, Alzheimer’s, malignancies,
musculoskeletal issues and gastrointestinal disturbances.

Thus according to a surgeon general report recently released,
a patient in a long term care facility like a nursing home is on
an average of 8 medications.

All of these conditions may adversely affect geriatric oral
health via the course of the disease itself or the treatment
modalities for the disease, similarly oral health may negatively
impact these disease processes as well.

As people live longer, disease processes
become chronic conditions to contend with in
attempting to achieve systemic and oral health
for these patients.

Unfortunately there are many obstacles that
geriatric patients must overcome in order to
receive healthcare.

Among these are education (other hcp’s do not
know the importance of oh) and awareness,
poor systemic health of these pts., poor OH,
lack of preventative services as well as a
shortage of dentists with an adequate comfort
level in treating these patients.

According to James S. Marks, M.D., M.P.H.,
Director of the National Center for Chronic
Disease Prevention and Health Promotion

".... Research has shown that poor health
does not have to be an inevitable consequence
of growing older. Death is inevitable, but, for
many people, it need not be preceded by a
slow, painful, and disability- ridden decline.
Our nation will continue to age -- that we
cannot change -- but we can delay and in
many cases prevent illness and disability."
 Patient
stability in tolerating dental
treatment in an office setting is of extreme
importance and medical consults with the
pt’s physicians are warranted.
 In
this way the dentist can be aware of
medical conditions and polypharmacy that
may require the need for antibiotic
prophylaxis, cause bleeding issues, delayed
healing time, overgrowth of oral tissue and
increased caries risk.
 This
lack of training and experience
begins in dental school where
courses in geriatric dentistry is sparse.
 This
unfortunately leads to a decreased
competency not only in treating patient’s
with these illnesses but also in
communicating with the pt’s physician’s
when additional information for treating
the patient is necessary.
 Medical
consults should be a way of a
physician and dentist communicating each
others concerns for the patient’s health.

The dentist should be knowledgeable
about medical issues that may preclude a
patient from being treated safely in a
dental operatory such as unstable angina,
uncontrolled seizures or brittle diabetes.
 The
bottom line is that the general dentist
needs to grow professionally and learn
more about clinical medicine so that this
increasing group of patients can be treated
safely and in a complete manner.
 By
doing this the general dentist may also
find that there are some patient’s that they
cannot treat in a safe manner and may
need to be referred to specialists or other
dentists who have credentials to treat the
patient in an OR setting if necessary.

Comprehensive 4-year curriculum

Interdisciplinary instruction

Didactic and clinical components

Virtual aging patient CD CD-ROM

Extramural rotations

Residencies and Fellowships

www.dhs.wisconsin.gov/rl_dsl/training/OrlCrPwrP
nt.pdf
 So
how does a general dentist increase
their comfort level in requesting medical
consults and providing care to these these
patients?
 Continuing
education courses that focus on
treating medically compromised individuals
 AEGD
or GPR residency
 Geriatric
Dentistry Fellowships